Eulalee Thompson - BE WELL

A vaccine against cervical cancer, the second leading form of cancer among Jamaica's women, and a leading cause of death here, is available, but it is not on the government's immunisation schedule.

There are not many cancers that can be prevented with a vaccine. The breakthrough discovery that cervical cancer is linked to the human papilloma virus (HPV), a sexually transmitted viral infection, sets the stage for making this killer disease history. Scientists say that there are about 200 types of HPV. Most of them cause genital warts, but some of them are associated with the development of cancer in the cervix, the neck of the womb.

No comments fromHealth Ministry

Comments from the health ministry on the absence of the vaccine from the immunisation schedule were not forthcoming, but in July 2005, Dr Karen Lewis-Bell, director of the health ministry's family health services, was reported as saying that a proper cost-benefit analysis would have to be done and compared with continuing the current Pap smear screening test for cervical cancer. It is not clear whether the analysis was done.

Dr Wendel Guthrie, well-known local gynaecologist and a member of both Jamaica's and Pan American Health Organisation's technical advisory group on cervical cancer, said that the course of HPV vaccine treatment is expensive. It costs about US$360 for the quadrivalent vaccine, which protects against four types of HPV (6, 11, 16 and 18). Types 16 and 18, Guthrie said, are associated with 70 per cent of cervical cancers and the other 30 per cent are due to HPV types, such as 33, 45 and 54.

Guthrie, who has been associated with cervical cancer vaccine development since 1985, indicated that three vaccines are required for protection against cervical cancer; the second one is given six weeks after the first and then six months later the candidate receives the third vaccine.

Inadequate screening

While there is a screening test, the Pap smear, to detect precancerous changes in the cervix, research by Professor Horace Fletcher indicates that 90 per cent of women who die from cervical cancer have never been screened.

Research by Fletcher (published in Caribbean Health, April 1999) indicates that "the effectiveness of Pap smear screening depends on women's knowledge of and attitudes toward screening, the availability of this service, the adequacy of laboratory facilities to process the smears, staffing of clinics and laboratories, quality control, a system of recall of women with positive smears and economic factors".

Fletcher continues: "Most women have heard of the Pap smear, but believe its purpose is to detect rather than prevent cervical cancer. Screening rates are low among poor, uneducated women. As a result of staff shortages in government laboratories, there is a long delay before Pap smear results are returned. The problem of cervical cancer is severe enough in Jamaica to justify the reallocation of funds from less critical area."

A 1999 study in the West Indian Medical Journal indicates that cervical cancer accounted for 62 per cent of 2862 gynaecologic cancers (in Kingston and St Andrew) between 1973 and 1997. The study indicates 268 gynaecologic cancer-related deaths (168 due to cervical cancer) in 1999 representing about 15 per cent of all female cancer-related deaths.

The study further states that the present incidence (27.9 per 100,000) and mortality rate (15.8 per 100,000) of cervical cancer are much higher than that documented for American women, both African Americans and caucasians and points to limited success in efforts to decrease the incidence and mortality of cervical cancer through screening.

There are two vaccines available, Guthrie indicated Gardasil, created by Merk & Co Inc, is effective against four HPV types (6, 11, 16 and 18) and Cervarix by GlaxoSmithKline, which is effective against two HPV types (16 and 18). The vaccine is recommended for routine immunisation in females who have not yet had sex.

Eulalee Thompson is health editor and a professional counsellor. Email: eulalee.thompson@gleanerjm.com.

Most women have heard of the Pap smear, but believe its purpose is to detect rather than prevent cervical cancer.